| Koushan Azad Dental Corpopration | |
|
3870 Broad St Ste 1 San Luis Obispo CA 93401-7172 | |
| (630) 624-5788 | |
| Not Available |
| Full Name | Koushan Azad Dental Corpopration |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3870 Broad St Ste 1, San Luis Obispo, California |
| Authorized Official Name and Position | Olivia Aguinaga (BUSINESS COORDINATOR) |
| Authorized Official Contact | 6308087290 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koushan Azad Dental Corpopration 5903 Annie Oakley Rd Hidden Hills CA 91302-1230 Ph: () - | Koushan Azad Dental Corpopration 3870 Broad St Ste 1 San Luis Obispo CA 93401-7172 Ph: (630) 624-5788 |
| NPI Number | 1477030351 |
|---|---|
| Provider Enumeration Date | 07/24/2018 |
| Last Update Date | 07/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477030351 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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